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Stroke Awareness in New Zealand Communities


In 2015 LENScience in association with the Brain Research Centre, University of Auckland, undertook a study into the public understanding of stroke. This page provides some background information on how the study was performed, presents some of the results, and links to the published paper.

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Stroke awareness and the mission of our study


New Zealanders have the second highest rate of stroke in the developed world1. Early detection of stroke is critical for effective treatment2. We know that if a patient reaches hospital for treatment within 6 hours of experiencing a stroke, the treatment will be significantly more effective in preventing loss of lifethan if there is a delay in getting medical help.

There have been many campaigns to increase public awareness of stroke and its symptoms; however, a large-scale measurement of existing public awareness of the causes, symptoms, and risk factors for stroke had not been conducted.

This study set out to gauge the public's understanding of stroke, so that future stroke awareness campaigns can be better targeted. To help achieve this goal, we measured the general public’s stroke awareness via a survey in Auckland.

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Who participated in our study?


Ethnicity response and Aucklanders

Our study recruited 850 Aucklanders aged 16 and over to participate in this study.

We selected a range of participants so that overall those surveyed closely represented the demographic characteristics of the greater Auckland adult population; characteristics such as age, ethnicity, and level of formal educational achievement. 

 

 

How do we know what the Auckland population looked like?

Statistics New Zealand undertake a nationwide population count every 5 years. This tells them how many people and dwellings there are in New Zealand, and take a snapshot of the people and the places where we live. 

They collect data on age, culture, income, sex/gender, religion, smoking behaviour, where we live, how many people we live with, transport and communication, volunteer activities, and many other things.

We used some of the basis categories from the NZ Census (age, sex/gender, ethnicity, and level of educational achievement), to identify the demographic characteristics of the wider Auckland population. 

More information on the New Zealand population, as collected in the 2013 census (the most recent), can be found on the Statistics NZ website.

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We asked 'What is Stroke?'


blood brain 42.7

A stroke is caused by a sudden interruption of blood flow to a part of the brain4. The affected part of the brain stops functioning and eventually becomes damaged. A stroke involves both blood and the brain as key components of the disease.

In our study, less than half of participants correctly identified blood and the brain as the two main components of a stroke.

However, different groups of people in our study had different levels of knowledge about stroke.

% of each group that identified both blood and the brain

Stoke knowledge varied by education

We were interested to find out whether people knew that stroke involves both blood and the brain.

Overall, only 42.7% of respondents identified stroke as involving both blood and the brain. Only half of university graduates were aware of the components of a stroke. This number was lower for individuals with no formal education, secondary education, or vocational education.

In the graphic on the right, the blue figures represent the percentage of participants from each level of eductional attainment that correctly identified both blood and the brain as components of stroke. 

Our data suggests that a stroke awareness campaign that targets younger people would increase the overall stroke awareness of the New Zealand public.

% by ethnicity - identified both blood and the brain

Stroke knowledge also varied by ethnicity

Using the standard categories provided in the NZ Census, study participants were placed in one of the following ethnic categories (based on the category they most identified with): European, Māori, Asian, Pacific, and Middle Eastern/Latin American/African.

The green figures show the percentage of each category that correctly identify both blood and the brain as components of stroke. For example, 23% of participants in our study who identified as Asian correctly identify that stroke involves both blood and brain components; this means that 77% did not know that stroke involved both blood and the brain.

Our study showed that we need to improve stroke knowledge in the general New Zealand public. There is also a need for stroke awareness campaigns specifically designed for ethnic groups in New Zealand. A current example is the Stroke Foundation’s programme focussing on stroke awareness in Pacific Islanders5.

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We asked 'What are Stroke risk factors?'


risk factors

Some of the key risk factors of stroke are:

 

diabetes, family history of stroke, high cholesterol, obesity, smoking, and stress.

 

We asked participants what they thought were risk factors of stroke. We did not give them a list to select from. 

Risk factors

What risk factors did our participants know?

Some risk factors, such as smoking and poor diet, were better known than others, such as diabetes. However, more than half of those surveyed did not name any risk factors.

Our data indicate a serious need for stroke awareness campaigns to provide more information about the risk factors of stroke.

 

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Identifying a stroke with F.A.S.T.


FAST

 

F.A.S.T is the internationally used checklist for recognising stroke.

 

FACE  |   ARMS  |  SPEECH  |  TIME

 

The checklist:

* Is one side of their FACE drooping?

* Can they only keep one ARM raised?

* Is their SPEECH slurred or jumbled?

* If so, it is TIME TO CALL 111.

F.A.S.T is the internationally used checklist for recognising stroke.

 

Face   |   Arms   |   Speech   |   Time

 

Is part of their FACE drooping?

Do they have ARM weakness

Is SPEECH difficulty?

If it is yes to any of these, it is TIME TO CALL 111.

F.A.S.T is the internationally used checklist for recognising stroke.

 

Face   |   Arms   |   Speech   |   Time

 

Is part of their FACE drooping?

Do they have ARM weakness

Is SPEECH difficulty?

If it is yes to any of these, it is TIME TO CALL 111.

F.A.S.T is the internationally used checklist for recognising stroke.

 

Face   |   Arms   |   Speech   |   Time

 

Is part of their FACE drooping?

Do they have ARM weakness

Is SPEECH difficulty?

If it is yes to any of these, it is TIME TO CALL 111.

How well did Aucklanders identify components of the potentially life-saving F.A.S.T. acronym?

FAST knowledge

Most Aucklanders knew that contacting emergency services as soon as possible is critical for someone having a stroke. However, few Aucklanders are familiar with all of the F.A.S.T. components:

  • 1.7% identified 4 components,
  • 11.5% identified 3 components,
  • 31.6% identified 2 components,
  • 41.8% identified 1 component,
  • 13.4% identified 0 components.

Aucklanders know to react quickly when someone is having a stroke, but many Aucklanders don’t know how to identify if someone is having a stroke.

A copy of the full article can be read here, or on the Journal of Stroke and Cerebrovascular Disease website.

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What do we do with our findings?


To reduce the damage caused by a stroke, immediate recognition and action is needed. Therefore, it is crucial that all New Zealanders understand the dangers of a stroke and the signs that someone is having a stroke. We found that while most Aucklanders know to contact emergency services if someone is having a stroke, Aucklanders are not well informed about what a stroke actually is or how to identify if someone is having a stroke.

We found that higher education is associated with more knowledge of stroke. The proportion of participants in our study with higher education is greater than the proportion of Aucklanders with high education; this means that our study may be overestimating stroke knowledge in the Auckland community. A possible consequence of overestimating stroke knowledge is that future stroke victims may be at a greater risk of not being correctly identified and treated in time.

Reduced knowledge and awareness of stroke is associated with delays in seeking urgent medical care,6, 7, 8 which leads to negative outcomes for the stroke patient. Recognition of stroke symptoms was previously increased through campaigns promoting the F.A.S.T. system9. Although the Stroke Foundation of New Zealand has been promoting the F.A.S.T. system since 2005, limited funding has prevented large-scale campaigns. Campaigns could target specific groups of people who are most at risk of developing stroke and who we found to have the lowest awareness of stroke components and visible stroke symptoms.

Stroke awareness may not be the same across New Zealand. Further research is needed to investigate access to stroke information in high-risk communities and communities with smaller populations than Auckland. The rates of stroke knowledge we observed in different ethnic groups suggest that current stroke awareness campaigns may need to be adjusted to better reach all New Zealanders.

 

A copy of the full article can be read here, or on the Journal of Stroke and Cerebrovascular Disease website.

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How did the project come about?


The study arose from a collaboration between the LENScience Biomedical Summer Programme and the Centre for Brain Research at the University of Auckland.

The LENScience Biomedical Summer Programme  provides final year high school and undergraduate students with learning opportunities associated with a hands-on introduction to scientific research.

Who are we?

The Liggins Education Network for Science (LENScience) provides schools with access to scientific research communities promoting connections between schools and scientists. Innovative programmes are designed to inspire schools and scientists to maximise student potential and understanding of science and health issues through a wide range of learning opportunities for students, teachers, and families.

The Centre for Brain Research at the University of Auckland is a unique partnership between scientists, doctors and the community. Working together in the laboratory, clinic, whānau, and community, they work to provide a brighter and better future for people and families living with brain disease.

 

Acknowledgements

Thank you to all those people that participated in the project: the people interviewed, the people asking the questions, those entering the information into the database, those that did the data analysis, and finally the people that wrote and submitted the paper to the Journal of Stroke and Cerebrovascular Diseases.

The questionnaire was conducted outside a number of The Warehouse stores around Auckland, and we thank the individual Warehouse stores for giving permission for this to take place. 

Thank you also to The Stroke Foundation of New Zealand for the provision of access to data from unpublished market research associated with public understanding of stroke; and Gravida: National Centre for Growth and Development and the Friedlander Foundation for funding the LENScience BioMed Summer School programme, which led to this study.

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References

1. Murray CJ, Vos T, Lozano R, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012;380(9859):2197-223. http://www.sciencedirect.com/science/article/pii/S0140673612616894

2. Marler JR, Tilley BC, Lu M, et al. Early stroke treatment associated with better outcome: the NINDS rt-PA stroke study. Neurology 2000;55(11):1649-55. http://www.neurology.org/content/55/11/1649.long

3. Wardlaw JM, Sandercock PA, Berge E. Thrombolytic therapy with recombinant tissue plasminogen activator for acute ischemic stroke: where do we go from here? A cumulative meta-analysis. Stroke 2003;34(6):1437-42. http://stroke.ahajournals.org/content/34/6/1437.long

4. Stroke Foundation of New Zealand. Understanding and preventing stroke and transient ischaemic attack. Wellington; 2012. http://www.stroke.org.nz/resources/Understanding-booklet-2012-web.pdf

5. Stroke Foundation of New Zealand. Pacific Stroke Prevention Project. http://www.stroke.org.nz/pacific

6. Das K, Mondal GP, Dutta AK, et al. Awareness of warning symptoms and risk factors of stroke in the general population and in survivors stroke. Journal of Clinical Neuroscience 2007;14(1):12-6. http://www.sciencedirect.com/science/article/pii/S0967586806005066

7. Wester P, Rådberg J, Lundgren B, et al. Factors associated with delayed admission to hospital and in-hospital delays in acute stroke and TIA: a prospective, multicenter study. Stroke 1999;30(1):40-8. http://stroke.ahajournals.org/content/30/1/40.long

8. Kim YS, Park SS, Bae HJ, et al. Public awareness of stroke in Korea: a population-based national survey. Stroke 2012;43(4):1146-9. http://www.ncbi.nlm.nih.gov/pubmed/22156687

9. Brownstein JN. Addressing heart disease and stroke prevention through comprehensive population-level approaches. Preventing Chronic Disease 2008;5(2):A31. http://www.cdc.gov/pcd/issues/2008/apr/07_0251.htm